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Maternal Mortality in a Nigerian Maternity Hospital

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Maternal Mortality in a Nigerian Maternity Hospital African Journal of Biomedical Research, Vol. 11 (2008); 267 – 273 ISSN 1119 – 5096 © Ibadan Biomedical Communications Group Full Length Research Article Maternal Mortality in a Nigerian Maternity Hospital *Olopade, F.E. and Lawoyin, T.O. Department of Community Health, College of Medicine, Full-text available at University of Ibadan, Nigeria. http://www.ajbrui.com http://www.bioline.br/md http://www.ajol.com Despite recent focus on maternal mortality in Nigeria, its rates remain unacceptably high in Nigeria. A retrospective case-control study was carried out at Adeoyo Maternity Hospital, Ibadan between January 2003 and December 2004. This was to determine the maternal mortality ratio in a secondary health facility, to identify the causes of death and to assess factors associated with these deaths. The case files of all maternal deaths that occurred in the hospital during the two years period were retrieved and data extracted into a study proforma. Each maternal death was matched with three controls that delivered the same day and live around the same area of Ibadan. Bivariate analysis of the data was done with the cases and controls compared in relation to various risk factors. There were 8,724 lives births and 84 maternal deaths giving a MMR of 963/100,000 live births. The main causes of the death were haemorrhage 20 (23.8%) sepsis 20 (23.8%) and eclampsia 14(16.7%). Nine women (10.7%) died while pregnant, 11 (13.1%) died in labour, 52 (61.7%) died after delivery while 12 (14.3%) died from post-abortal complications. Most of the deaths due to post-partum heamorrhage Received: (66.7%) were seen in mothers over the age of 29 years while 64.2% of deaths due to February 2008 eclampsia were in women under the age of 25 years due to eclampsia occurred in nulliparous women and PPH was responsible for deaths in more women as their parity Accepted (Revised): increased from two. From bivariate analysis, factors significantly associated with June 2008 maternal death included unbooked status {Odd’s ratio OR=12.89 (95%C.I. _ 6.9 – 24.1) p<0.05}, grandmultiparity (parity>5) {OR=4.17 (95% C.I. – 1.53-11.45) p< 0.05} Published and prolonged labour (>18 hours) {OR=2.86, (95% C.I. 1.5 – 5.9) p< 0.05}. It is Septemebr 2008 necessary to improve the quality of emergency obstetric service as well as reduce the cost and to educate women of reproductive age in Ibadan on the importance of booking for antenatal care and family planning. (Afr. J. Biomed. Res. 11: 267 - 273) Key words: Maternal mortality, case-control study, maternal death, antenatal care, emergency obstetric care *Corresponding author’s address: [email protected] Abstracted by: African Index Medicus (WHO), CAB Abstracts, Index Copernicus, Global Health Abstracts, Asian Science Index, Index Veterinarius, Bioline International , African Journals online African Journal of Biomedical Research 2008 (Vol. 11) / Olopade and Lawoyin INTRODUCTION principal medical officers. There is no blood bank in the hospital and patients are required to procure Pregnancy and childbirth is a normal physiological blood from the State Transfusion Service or private process bringing a joyful experience to individuals laboratories around the hospital. The 16 bedded and families. However, in many parts of the world, labour ward records a delivery rate of 4,000-45,000 pregnancy and childbirth is a perilous journey, a annually. risky and potentially fatal experience for millions of All the maternal deaths that took place at the women especially in developing countries. This is in hospital between January 1, 2003 and December 31, spite of evidence which shows that motherhood can 2004 (a 2-year period) were identified. A maternal be safer for all women (De Browere, 1998), by a set death was defined as the death of a woman while of life-saving strategies that can work even in low pregnant or within six weeks of the end of resource settings (Shiffman, 2000). pregnancy irrespective of the duration or site of the The average maternal mortality rates in pregnancy, from any cause related to or aggravated developed countries is between 10-15/100,000 live by pregnancy and its management (WHO, 1992). births while developing countries record rates 100- Each maternal death was matched with three 200 times this number (Rosenfied, 1989). The controls that delivered on the same day and live problem of maternal deaths is worst in sub-Saharan within the same ward and similar socio-economic Africa with the maternal mortality rates there being area of Ibadan. The case files of all these women higher than anywhere else in the world (WHO, were retrieved from the Medical Records 2004). The situation in Nigeria is especially grave as Department and data extracted into a study we still record maternal mortality rates in the order proforma focusing on socio-demographic and of 800-1,000 per 100,000 live births (N.P.C. 2003) obstetric characteristics including age, parity, and thus rank among the nations with the highest occupational status, booking status, season of number of maternal deaths (WHO, 2004). Nigeria delivery and length of hospital stay before death as makes up only 1.7% of the total world population, well as cause of death where applicable. Data were but accounts for about 10% of the global estimate entered into a computer database using SPSS for maternal mortality (Grant, 1990). version 12 and statistical analysis was performed. A lot of work has been done on maternal Bivariate analysis was done using Epi-info 6. The mortality in tertiary health institutions, which have a odd’s ratios were generated to establish the high selection of complicated cases. In order to exposure as a risk factor for death. Maternal obtain a true picture of the epidemiology of mortality ratio was calculated as the number of maternal mortality in Ibadan, this study was carried maternal deaths per 100,000 live births (WHO, out in a secondary health facility to which primary 1992). health care facilities refer patients. Ethical approval was obtained from the Oyo State Ethical Review Committee and the MATERIALS AND METHODS management of the facility used. This is a retrospective case - control study of RESULTS maternal deaths which was conducted in Adeoyo Maternity Hospital. It is an 80-year-old state-owned During the study period, a total of 84 maternal General Hospital in Ibadan city, Nigeria. It is highly deaths and 8,724 live births were recorded at the patronized by Ibadan residents especially those of hospital. Table 1 shows a review of the socio- low and middle socio-economic status. It also serves demographic characteristics of the cases and as a referral center for many primary health centers controls and reveals no significant differences and private clinics within Ibadan and its environs. between them except for parity and booking status. The Obstetrics and Gynaecology department of Most of the women (70.2% of the cases and 72% of the hospital has 2 consultants and about 10 doctors the controls) were unskilled, mainly petty traders. including medical officers, senior medical and The study maternal mortality ratio was 268 Maternal mortality in Nigeria African Journal of Biomedical Research 2008 (Vol. 11) / Olopade and Lawoyin calculated as 963/100,000 live births. Direct increased significantly as the parity of the women obstetric deaths were 75 (89.3%) while indirect increased; no deaths in women with parity below obstetric deaths were 9 (10.7%). About 61.9% of the 2, 23.5% of deaths in women with parity of 2, and maternal deaths occurred post-partum, 13.1% intra- 36.4% of women with parity ! 5. partum and 10.7% ante-partum while 14.3% of the women died from post-abortal complications. The main causes of death were haemorrhage 20 (23.8%), sepsis 20 (23.8%), eclampsia 14 (16.7%), post- abortal complications 11 (13.1%) and obstructed labour 10 (11.9%) (Figure 1). Table 1: Socio-Demographic Pattern of Cases Characteristics Cases N (%) AGE (YEARS) 15-19 6 (7.1) 20-24 15 (17.9) 25-29 35 (41.7) 30-34 20 (23.8) ! 35 8 (9.5) PARITY 0 21 (25) 1 12 (14.3) Figure 1: Causes of Maternal Death at Adeoyo Maternity 2 17 (20.2) Hospital (2003-2004) 3 11 (13.1) *Includes ante-partum haemorrhage (APH) and post-partum 4 10 (11.9) haemorrhage (PPH) **Anaesthetic deaths, Pulmonary TB. ! 5 11 (13.9) Not recorded 2 (2.4) Length of admission and Cause of Death: Most OCC. STATUS of the eclamptic deaths (85%), deaths due to Higher (Prof. and Skilled 6 (7.2) obstructed labour (80%) and post-partum Lower (Unskilled) 59 (70.2) haemorrhage (73.3%) occurred within 24 hours of Unemployed 19 (22.6) admission, but at least 40% of deaths due to sepsis BOOKING STATUS occurred after 72 hours of admission. Booked 23 (27.4) Booking Status and Cause of Death: Deaths due Unbooked 61 (72.6) to sepsis (75%), eclampsia (71.4%), ante-partum SEASON OF DELIVERY haemorrhage (100%) and obstructed labour (80%) Dry (November—March) 36 (42.9) occurred more in unbooked women while almost Wet (April—October) 48 (57.1) equal proportions of booked and unbooked women died due to post-partum haemorrhage and Table 2 compares the obstetric history of the cases anaemia. with their various causes of death. Season of Delivery and Cause of Death: Significantly more eclamptic deaths were seen in Age and Cause of Death: Most of the deaths due the rainy season (x2 = 5.14 1 d.f. p = 0.023) as well to post-partum haemorrhage (66.7%) occurred in as deaths due to obstructed labour (x2 = 3.2 1 d.f.
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